The consequences of the international community’s failure to protect Syrians from systematic and repeated violations of both human rights and humanitarian law have been devastating. Yet, one in particular stands out: the erosion of the long-established principle that neither militaries nor armed groups can target medical workers and the health care system for attacks.

Since 2011, the Syrian government has systematically violated this principle and is using attacks on medical workers and facilities as a weapon of war. It began when the government interfered with and compromised health care services by arresting injured protesters in emergency rooms, but quickly escalated into bombing hospitals in opposition-held areas and detaining, torturing, and executing doctors who were adhering to medical ethics by treating the wounded regardless of their political beliefs. The doctors who have risked their lives to remain in Syria and treat the injured have been decimated by Bashar al-Assad’s forces, which consider it a crime punishable by death to provide medical treatment to “the other side.”

As we approach the fifth year of the conflict, at least 610 medical personnel have been killed, and there have been 233 deliberate or indiscriminate attacks on 183 medical facilities. The Syrian government is responsible for 88 percent of the recorded hospital attacks and 97 percent of medical personnel killings, with 139 deaths directly attributed to torture or execution.

These numbers are conservative given difficulties in reporting during a war. But one thing is certain, these attacks are deliberate and have a cascading effect on the health of Syrians.